in future front-line environments. If this becomes thecase, longer ground chains of evacuation to thebattalion aid station or division clearing station may berequired. This will increase the need for life-stabilizingactivities before each step in the chain and in transit.Evacuation triage will normally be used for personnelin the Class II and Class III treatment categories, basedon the tactical situation and the nature of the injuries.Class IV casualties may have to receive treatment atthe BAS level, and Class I personnel will be treated onthe line.Remember, triage is based on the concept of savingthe maximum number of personnel possible. In somecases, a casualty may have the potential to survive, butto ensure that casualty's survival, the treatmentnecessary may require a great deal of time andsupplies. As difficult as it may be, you may have toforsake this patient to preserve the time and suppliesnecessary to save others who have a greater potentialfor survival.PATIENT ASSESSMENT IN THE FIELDLEARNING OBJECTIVE:Recognize theassessment sequence for emergency medicalcare in the field, and identify initial equipmentand supply needs.Patient assessment is the process of gatheringinformation needed to help determine what is wrongwith the patient. Assessments that you conduct in thefield (at the emergency scene) or during transport areknown as a field assessments.Field assessments are normally performed in asystematic manner. The formal processes are knownas the primary survey and the secondary survey. Theprimary survey is a rapid initial assessment to detectand treat life-threatening conditions that requireimmediate care, followed by a status decision about thepatient’s stability and priority for immediate transportto a medical facility. The secondary survey is acomplete and detailed assessment consisting of asubjective interview and an objective examination,including vital signs and head-to-toe survey. (Bothtypes of surveys will be discussed in more detail laterin this chapter.)BEFORE ARRIVAL AT THE SCENEBefore or during transit to an emergency scene,you may learn about the patient’s illness or injury.Although this information could later prove to beerroneous, you should use this time to consider whatequipment you may need and what special proceduresyou should use immediately upon arrival.ARRIVAL AT THE SCENEWhen you arrive at an emergency scene, you needto start gathering information immediately. First,make sure the scene is safe for yourself, then for thepatient or patients. Do not let information you receivedbefore your arrival form your complete conclusionconcerning the patient's condition. Consider all relatedfactors before you decide what is wrong with thepatient and what course of emergency care you willtake.You can quickly gain valuable information as towhat may be wrong with the patient. Observe andlisten as you proceed to your patient. Do not delay thedetection of life-threatening problems. Be alert toclues that are obvious or provided to you by others.Some immediate sources of information may comefrom the following:The scene¾Is it safe or hazardous? Does thepatient have to be moved? Is the weather severe?The patient¾Is the patient conscious, trying totell you something, or pointing to a part of hisbody?Bystanders¾Are they trying to tell yousomething? Listen. They may have witnessedwhat happened to the patient or have pertinentmedical history of the patient (for example, priorheart attacks).Medical identification device¾Is the patientwearing a medical identification device (necklaceor bracelet)? Medical identification devices canprovide you with crucial information on medicaldisorders, such as diabetes.Mechanism of injury¾Was there a fire? Didthe patient fall or has something fallen on thepatient? Is the windshield of vehicle cracked orthe steering wheel bent?Deformities or injuries¾Is the patient lying ina strange position? Are there burns, crushedlimbs, or other obvious wounds?Signs¾What do you see, hear, or smell? Is thereblood around the patient? Has the patientvomited? Is the patient having convulsions?Are the patient’s clothes torn?4-3
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